When a patient has an abdominal wall incision for open surgery of any type, incisional hernias can occur in as many as 1 in 10 patients (or more often depending on a variety of patient specific risk factors). These hernias may appear immediately after surgery or even several years later. In laparoscopic incisional hernia repair procedures, multiple small incisions are made throughout the abdomen and surrounding the hernia defect rather than one large incision as is the case for open repair. With the patient asleep, carbon dioxide gas is used to distend the abdominal cavity and create space for the surgeon to work during the repair. The surgeon navigates throughout the abdominal cavity using a long thin camera (laparoscope) to project an image from inside onto a video screen. Once all adhesions and scar tissue have been cleared from the abdominal wall, a piece of thin and pliable surgical mesh is rolled and pulled into the abdomen through a tiny incision and laparoscopic port site. The mesh is unrolled and then used to repair the hernia defect using a combination of sutures and tacks to fix the mesh into place.
Not every incisional hernia can or should be repaired laparoscopically. Some patients require or will do much better with a more extensive abdominal wall reconstruction. There are a variety of techniques that can be used to accomplish this reconstruction. Your surgeon can help to determine the best approach. Additional testing (such as an abdominal CT scan) or consultation (with Condon Hernia Institute providers) may be necessary for complicated cases. For a full discussion of the risks, options, and alternatives to incisional hernia repair, please make an appointment with a surgeon.
One in four men will develop or be diagnosed with an inguinal hernia at some point in his lifetime. Today, inguinal hernia repair is one of the most common operations performed by general surgeons - nearly 600,000 operations are performed annually in the United States. The most common reason to repair a hernia is to correct pain and discomfort related to the presence of this hernia. Some inguinal hernias may become stuck or “incarcerated” necessitating a more urgent procedure. Inguinal hernias can be repaired with an open approach (a single larger incision in the groin) or a laparoscopic approach (several smaller incisions, also called a minimally invasive approach). There are advantages and disadvantages to each technique.
Open Inguinal Hernia Repair
There are a variety of techniques employed for open inguinal hernia repair. Most of the time, a piece of mesh is used for reinforcement during the repair. Without mesh, the risk of the hernia coming back again (recurrence) is quite high in most cases. The mesh used in inguinal hernia repair is usually synthetic material that looks like a screen. Mesh comes in many different shapes, sizes, and is made from a variety of materials. In open inguinal hernia surgery, a single incision is made in the groin. This incision is larger than what is required for a laparoscopic hernia repair. Certain hernias are best repaired in an open manner. Long term outcomes for hernia repairs performed in an open or a laparoscopic manner are similar. For a full discussion of the risks, options, and alternatives to an open approach, please make an appointment with a surgeon.
Laparoscopic Inguinal Hernia Repair
Laparoscopic techniques for inguinal hernia repair were first introduced about 20 years ago. Despite this fact, only about 1 of every 5 inguinal hernia repairs is currently performed laparoscopically. The majority of inguinal hernia repairs in this country are still performed with an open technique through a larger groin incision. This may at least partially relate to the fact that laparoscopic inguinal hernia repair techniques are difficult to master. Open inguinal hernia repair is much easier to learn. They are both good techniques with excellent results in experienced hands.
Some of the advantages to a laparoscopic inguinal hernia repair when compared to an open technique include:
The possibility that there is less pain immediately following surgery.
A potential for a quicker return to work and full activities.
Bilateral (left and right) inguinal hernias can be repaired during the same laparoscopic procedure without additional incisions.
Hernias that have already been repaired with an open technique that ultimately recur are likely best approached laparoscopically.